Loading...
HomeMy WebLinkAboutASPEN HEIGHTS CONSTRUCTION LLC - INSURANCE CERTIFICATE (2)Client#: 99381 14ASPENHEI ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTPRODUCER NAME, Shelia Moore, CIC, ACSR Wortham Insurance & Risk Mgmt. PHONE 453-0031 FAX 512 453-0041 A/C .,):512 A/C No 221 West 6th Street, Suite1400 IL ADDRESS: shelia.moore@worthaminsurance.com Austin, TX 78701 INSURERS) AFFORDING COVERAGE NAIC# 512 453-0031 INSURERA: Ironshore Specialty Insurance C 25445 INSURED INSURER B : Starr Indemnity & Liability Com 38318 Aspen Heights Construction, LLC INSURER C: Cincinnati Indemnity Company 23280 INSURER D : Hallmark Specialty Insurance Co 1301 S. wy, of Texas , Ste B-201 Capital H p" Austin, TX 78746 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM/DDIYYW POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY AGS0005404 7/19/2015 07/19/2016 EACHOCCURRENCE$1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR PREMISES (ERENTED nce)$ 50,000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1,000,000 X BI/PD Ded:5,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO- LOC JECT $ D AUTOMOBILE LIABILITY H4240068402 7119/2015 07/19/201 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ B UMBRELLA LIAB HxCLAIMS-MADE OCCUR 1000021994 7/19/2015 07/19/2016 EACH OCCURRENCE $10 000 000 AGGREGATE $10 000 000 X EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFF I CER/MEMBER EXCLUDED? ❑ N / A _ WC STATU- OTH- T RY LIMITS E L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Rented/Lease Equi ENP0309056 7/19/2015 07/19/2016 $250,000 any 1 item Rented/Lease Equi ENP0309056 7/19/2015 07/19/2016 $2,000,000 any 1 occ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Aspen Heights Construction, LLC, Ft Collins, Co The General Liability policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder when there is a written contract between the named insured and the certificate holder requiring additional insured status. (See Attached Descriptions) L911a\tya4W_1 City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 LaPorte Ave ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S565184/M564090 14CXS DESCRIPTIONS (Continued from Page 1) The General Liability and Excess Liability policy includes an endorsement providing 30 days notice of cancellation (or coverage change) will be furnished to the Certificate Holder. The General and Auto Liability Policy includes a blanket notice of cancellation to certificate holders endorsement, providing for 30 days advance notice if the policy is cancelled by the company other than for nonpayment of premium, 10 days notice after the policy is cancelled for nonpayment of premium. Notice is sent to certificate holders with mailing address on the file with the agent or the company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation. SAGITTA 25.3 (2010/05) 2 of 2 #S565184/M564090 POLICY NUMBER: AGS0005403 COMMERCIAL GENERAL LIABILITY CG 20 12 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: Whereas Required by Written Contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to 2. This insurance does not apply to: include as an insured any state or political a. 'Bodily injury," "property damage" or subdivision shown in the Schedule, subject to the "personal and advertising injury" arising out following provisions: of operations performed for the state or 1. This insurance applies only with respect to municipality; or operations performed by you or on your behalf b. "Bodily injury" or "property damage" included for which the state or political subdivision has within the "products -completed operations issued a permit. hazard". CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑